STATE OF NEVADA



STATE OF NEVADA

1

DCFS Staff Acknowledgement of Medication and Administration Management Training and Policy

I acknowledge that I have received the required DCFS training about Medication Administration and Management pursuant to DCFS SP-5 Medication and Administration for Residential Programs Policy from my supervisor. I also acknowledge that I have read and understand the DCFS SP-5 Medication and Administration for Residential Programs Policy dated _________________________.

Insert Revision Date of Policy

I understand this signed statement will be placed in my Agency Personnel File as confirmation that I have received this training and that I understand the policy and practice requirements.

____________________________________ ______________________________________

Print Employee’s Name Employee’s Signature

____________________________________

Date

By affixing my signature below, I confirm I am the supervisor of the above noted DCFS employee and that I have trained this DCFS staff member on the current Medication Administration and Management Policy. I further confirm that the DCFS staff member has demonstrated an understanding of this policy.

The training provided was: Initial Training ________________________________(Date)

Annual/Refresher Training _______________________ (Date)

____________________________________ _______________________________________

Supervisor’s Signature Date

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BRIAN SANDOVAL

Governor

Michael J. Willden

Director

Department of Health and Human Services

Amber Howell

Administrator

Division of Child and Family Services

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Department of Health and Human Services

Division of Child and Family Services

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